gastrointestinal system (gi tract) is a long tube that consists of the mouth, esophagus, stomach,...
TRANSCRIPT
Gastrointestinal System (GI tract)Is a long tube that consists of the mouth,
esophagus, stomach, small intestine, large intestine, rectum and anus
Several organs empty into the GI tract. These include the liver, pancreas, and the gall bladder with the salivary glands
The main function of the GI tract is digestion and absorption of nutrients
The movement of the smooth muscles in the GI is called peristasis and propels food in the forward direction
Mouth and oral cavityTeeth normally masticate food which
increases the surface area for digestive enzymes to work
Salivary amylase is secreted and begins the digestion of starch and complex carbohydrates into disaccharides and trisaccharides
The oral cavity is also called the pharanyxEsophagus delivers the food to the stomach
Stomach The stomach further processes the food into a
semisolid substance called chymeParietal cells of the stomach also secretes HCL HCL activates pepsinogen into active enzyme called
pepsin.Pepsin begins the breakdown of proteins in the food
into amino acid peptidesParietal cells also secrete intrinsic factor which is
important for absorption of vitamin B12 in the ileumBicarbonate in the mucus in the stomach is present to
protect the lining of the stomach from the low pH of the acid environment
Small IntestineDuodenum is the part of the small intestine where
most of the digestion occursPancreas secretes alkaline pancreatic juice which
contains an amylase which further breaks down sugars, chymotrypsin (which will break down proteins), lipases (which will break down fats)
Additional the liver produces bile acids and the gallbladder stores the acids until needed. When food enters the duodenum CCK is release and the gallbladder pumps bile acids into the duodenum
Bile acids solubilize the fats into micelles to increase the surface area for pancreatic lipase to work.
End products of DigestionCarbohydrates to glucose and/or FructoseProteins to amino acids and same peptidesFats to fatty acids and glycerolFats are transported via chylomicrons to the
liver where VLDL, and LDL are secretedThe enterocytes of the small intestine will
absorb these and the mesenteric veins will empty into hepatic portal vein which carries nutrients to the liver (first pass)
Large IntestineThe main function of the large intestine is to
absorb water and electrolytes into the blood stream
If too much water is absorb the result is constipation
If too little is absorbed the result is diarrhea
Disorders of the GI systemGastroesophegeal reflux or GERD
caused by abnormal amounts of acid in stomachor esophageal sphincter functionDefective prostaglandin synthesis and defective
bicarbonate production (NSAIDs, and ASA)Tx: antacids containing calcium carbonate (TUMS®) or
aluminum and magnesium hydroxide (MAALOX®)Alternatives are PPI (proton pump inhibitors)
Nexium ® (esomeprazole) Protonix® (pantaprazole) Aciphex® (rabeprazole) Prilosec® (Omeprazole) Drugs work on the parietal acids to block HCL secretion
Nausea and Vomiting (NV)Common seen in pregnancy, overeating, alcohol
consumption, illness, bacterial or viral gastroenteritis, food poisoning, and post operative states
A common side effect to opiate medicationsA common side to diabetic gastroparesisDrugs that are used to treat NV
5 HT3 agonist : ondansetron (Zofran®), granisetron (Kytril®) the gold standard in NV tx in chemotherapy
Dopamine blockers: Prochlorperazine (Compazine®): classical used in the morning sickness.
Dopamine blockers/GI stimulant: Metoclopramide (Reglan®) used in tx of diabetic gastroparesis
Malabsorption diseasesCeliac disease: autoimmune disease of the small intestine where
there is a senstivity to gluten Gluten also known as wheat protein is a trigger for this reaction. Results in severe diarrhea and profound electrolyte loss Malabsorption of fat soluble vitamins (bleeding disorder) Other names for this disease is nontropical sprue, or Gluten insensivity
Tropical Sprue: a disease causing the villi of the small intestine to stop absorbing nutrients. Can be fatal Profound loss of all nutrients and fat soluble vitamins Believe to be caused by a bacterial factor. Treated with a course of Abx: Doxycycline
Pancreatic disease including pancreatic cancer, pancreatitis and cystic fibrosis
Cholestatic jaundice
ConstipationResults from:
Inadequate water intakeInadequate fiber intakeChanges in lifestyleLack of exerciseDrugs like opiatesAbuse of laxatives
Therapy of constipationBulk forming laxative commonly include fiber which increases
bulk of stool to stimulate GI tract. Includes: Metamucil (psyllium)
Emollient makes the fecal matter “slippery” includes mineral oil enema (Fleet® mineral oil)
Surfactants makes the feces more soft: Colace ® (docusate sodium)
Saline laxative powerfully draws water into the stool. Includes magnesium citrate (Citroma®), and sodium phosphates (Fleet® Phosho Soda)
Evacuants work similar to saline laxatives: Golytely (PEG with lytes)
Stimulants: triggers the nerve that control bowel movements to work. Includes bisacodyl (Dulcolax®) and Senna (sennakot®)
Therapy of DiarrheaDiarrhea is a loss of water and electrolytes as a
result of infections or inflammation of the large or small intestine.
Bloody diarrhea is sometimes called dysentery and result in infection with salmonella (Typhus fever), shigella, or E. Coli Treated with Abx: fluoroquinolones or Bactrim
Cholera is disease of the third world where a spirochete, called Vibrio Cholerae infects the small intestine and its toxin produce profound loss of water and electrolytes. Potentially fatal if untreated with Abx and IV hydration
Diarrhea can be treated with fiber Absorbs water from the GI and swells to provide
bulkExamples are Metamucil® (natural psyllium hulk)
or fiber from fruits and vegetablesCan be treated with narcotics and narcotic
derivativesOpium Tincture® sig: 0.25 ml-0.5 ml bid as needed
to limit bowel movements. Caution: tincture as high concentration. Can result in overdose.
Lomotil® (Diphenoxylate/Atropine) CVImodium ®(Loperamide, a meperidine derivative)
Liver DiseaseLiver pathology includes hepatitis, cirrhosis,
and cancerDamage to the liver can also occur from
drugs. Drugs that can cause liver damage are: acetaminophen (Tylenol®), amiodarone (Cordarone®), anabolic steroids, isoniazid, oral contraceptive agents, methotrexate, allopurinol (Zyloprim®)
HepatitisInflammation of the liverCaused by viruses in most cases. Hepatitis B and C
is life long and can lead to hepatocellular carcinoma and cirrhosis of the liver. CMV can also cause hepatitis
Can be caused by drugsAlcoholHepatitis A virus (HAV)
Transmitted by oral-fecal route in endemic areaSymptomic therapy; not life longPrevented by vaccination: Havrix® (GSK) and Vaqta®
(Merck)
Hepatitis B (HBV)“serum hepatitis”Transmitted by blood or infected bodily fluid contact
with mucus membranes or by blood transfusions or by poorly sterilized medical devices (needles)
Can be transmitted to a fetus by an infected motherNew born babies are vaccinated at birth
Recombivax ® 0.5 ml IM or Energix ® 0.5 ml IM hepatitis B surface antigen (HBsAg) produced in yeast cells
Acute infection causes vomiting, abdominal pain, jaundice and sometimes hepatic failure and death
Chronic infection leads to cancer and cirrhosis
Therapy of HepatitisTherapy is complex and involved drug, antibody
level and viral load monitoringAntiviral drugs (similar to HIV drugs)
Lamivudine (Epivir®) Adefovir (Hepsera®) Tenofovir (Viread®) Entacavir (Baraclude®)
Interferons are drugs that modify the immune response to the viral infection Interferon alpha (Intron A®, Roferon®) Interferon alpha (peglyated): Pegasys® give weekly These drugs cool the immune reaction to viral does not
clear the infection
CirrhosisEnd stage liver diseaseFibrosis of the sinusoids of the liverComplications: bleeding, CNS edema, renal
dysfunction, ascites, hypoglycemia, hepatic bone disease (osteodystrophy), bleeding into the GI tract from varices
Terminal conditionChronic hepatitis and carcinoma leads to
cirrhosisExtreme alcohol consumptionLiver Transplant is only cure
Amino AcidsThe body can produce 11 types of amino
acids, referred to as nonessentialThere are 9 types of amino acids that the
body requires, but cannot produceThese are referred to as essential amino acids
(See table 23.9)Essential amino acids have to be derived
from food intake
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Vitamin DHelps with the absorption of calcium from
the intestine to make stronger bones and teeth
Deficiency causes metabolic bone softening:Called rickets in childrenCalled osteomalacia in adults
DRI is 5 µg/day (ages 19–50) for both males and females
DRI is 10 µg/day (ages 51–70) for both males and females
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Vitamin KNecessary for blood coagulationControls formation of coagulation factors II,
VII, IX, and X in the liverAlso needed for calcium uptake in bonesCan be used as an antidote for coumadin
overdosesDeficiency is rareDRI is 120 µg/day for males and 90 µg/day
for females
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Vitamin B1 (thiamine)Necessary for carbohydrate metabolismDeficiency causes the disease beriberi
Affects the peripheral neurologic, cerebral, cardiovascular, and GI systems
DRI is 1.2 mg/day for males and 1.1 mg/day for females
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Vitamin B3 (niacin)Important in oxidation-reduction reactionsVital in protein metabolismDeficiency leads to the disease pellagra:
Affects skin, mucous membranes, GI, and brain/CNS systems
Causes photosensitive rash, scarlet stomatitis, glossitis, diarrhea, and mental aberrations
Deficiency found in diets high in cornDRI is 16 mg/day for males and 14 mg/day
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Vitamin B6 (pyridoxine)Needed for:
Red blood cell formation - Antibody productionCell respiration - Cell growthConversion of tryptophan to niacinHelps convert stored carbohydrate to glucose to maintain
normal blood sugar levelsSynthesis of neurotransmitters such as serotonin and
dopamineDeficiency can cause:
Anemia similar to iron-deficiency anemiaDecreased antibody productionSuppressed immune responseSymptoms such as dermatitis, a sore tongue, depression,
confusion, and convulsions
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Vitamin B9 (folic acid)Important for:
Energy production -Formation of red blood cells
Strengthening immune systemPromoting healthy cell division and replicationProtein metabolismPreventing depression and anxiety
Deficiency can be serious and may result in:Anemia - ApathyDigestive disturbances - FatigueGrowth impairment - InsomniaLabored breathing - Memory problemsParanoia - Weakness
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